Irukandji-like syndrome caused by single-tentacle box jellyfish found in Thailand, 2007–2019
Abstract
Background: Irukandji syndrome definition is still widely misunderstood. Irukandji-like syndrome is more unclear than Irukandji syndrome. This study aimed to describe Irukandji-like syndrome in cases involving stinging by single-tentacle box jellyfish species in Thailand.
Materials and methods: Surveillance system and networks of toxic jellyfish incidents were established to enable case detection. In the period 2007 to 2019, all cases of stinging by single-tentacle box jellyfish resulting in collapse, hospital attendance or death were investigated.
Results: The majority of the 19 Irukandji-like syndrome cases were male (68.2%), median age 35.0 years (range 6.0–60.0), and Thai nationality (52.3%). Clinical manifestations of Irukandji-like syndrome were categorised as severe wound pain with immediate systemic reaction (66.7%), moderate wound pain with gradual systemic reaction (16.7%), and moderate wound pain with the immediate systemic reaction after a physical/chemical trigger (16.7%). The pain occurring when being stung differed from the pain occurring during the systemic reaction. The five most common symptoms were pain (100.0%), high blood pressure (100.0%), palpitations (86.7%), respiratory distress (52.6%), and near collapse/collapse (31.6%). The pain occurs when being stung was excruciating or burning pain at the wounds, felt like an electric shock, and rapidly expanded to heart pain. While the pain occurring during the systemic reaction was back pain, muscle pain, joint pain, abdominal pain, and body aches. The marks from the tentacles appeared similar in appearance to the caterpillar tracks of tanks. In 6 cases the species could be identified and all of them involving the Morbakka spp.
Conclusions: This was the largest study of Irukandji-like syndrome cases involving stings by single-tentacle box jellyfish in Thailand and the different clinical manifestations might be caused by different species of single-tentacle box jellyfish.
Keywords: Irukandji-like syndromebox jellyfishenvenomationsignsymptomdefinition
References
- Thaikruea L. A case study of thailand’s first toxic jellyfish networks and knowledge establishment. In: Socially-engaged scholarship. Bangkok, Thailand: Civil Society Engagement Thailand. 2016: 26–29.
- Thaikruea L. A decade of fighting the lethal jellyfish health problem: lesson learned. Proceedings of the 4th Asiaengage Regional Conference; 2018 Nov 26-28; Chiang Mai, Thailand. Chiang Mai: Chiang Mai University. 2018: 95.
- Thaikruea L, Siriariyaporn P. Surveillance system and prevention for injuries and deaths. In: Injuries and Deaths Caused by Toxic Jellyfish: Surveillance, Prevention, and Treatment. Chiang Mai: Faculty of Medicine of Chiang Mai University. 2018: 177–240.
- Sucharitakul P, Chomdej S, Achalawitkun T, et al. Chirodropid box jellyfish in the Gulf of Thailand. Marine Biodiversity. 2018; 49(3): 1247–1252.
- Thaikruea L, Santidherakul S. The public health impact of a new simple practical technique for collection and transfer of toxic jellyfish specimens and for nematocyst identification. J Public Health Policy. 2018; 39(2): 143–155.
- Thaikruea L, Siriariyaporn P. Severe dermatonecrotic toxin and wound complications associated with box jellyfish stings 2008-2013. J Wound Ostomy Continence Nurs. 2015; 42(6): 599–604.
- Thaikruea L, Siriariyaporn P. The magnitude of severe box jellyfish cases on Koh Samui and Koh Pha-ngan in the Gulf of Thailand. BMC Res Notes. 2016; 9: 108.
- Thaikruea L, Siriariyaporn P, Wutthanarungsan R, et al. Review of fatal and severe cases of box jellyfish envenomation in Thailand. Asia Pac J Public Health. 2015; 27(2): NP1639–NP1651.
- Thaikruea L, Siriariyaporn P. Jellyfish. In: Injuries and Deaths Caused by Toxic Jellyfish: Surveillance, Prevention, and Treatment. Chiang Mai: Faculty of Medicine of Chiang Mai University. 2018: 1–28.
- Thaikruea L, Siriariyaporn P. Nematocyst and identification technique. In: Injuries and Deaths Caused by Toxic Jellyfish: Surveillance, Prevention, and Treatment. Chiang Mai: Faculty of Medicine of Chiang Mai University. 2018: 157–176.
- Barnes JH. Cause and effect in irukandji stingings. Med J Australia. 1964; 1(24): 897–904.
- Gershwin, L. Morbakka fenneri, a new genus and species of Irukandji jellyfish (Cnidaria: Cubozoa). Mem Queensl Mus. 2008; 54(1): 23–33.
- Fenner PJ, Fitzpatrick PF, Hartwick RJ, et al. “Morbakka”, another cubomedusan. Med J Aust. 1985; 143(12-13): 550–555.
- Thaikruea L, Siriariyaporn P. Situation of injuries and deaths. In: Thaikruea L, editor. Injuries and Deaths Caused by Toxic Jellyfish: Surveillance, Prevention, and Treatment. Chiang Mai: Faculty of Medicine of Chiang Mai University. 2018: 29–84.
- Fenner P, Harrison S. Irukandji and Chironex fleckeri jellyfish envenomation in tropical Australia. Wilderness & Environmental Medicine. 2000; 11(4): 233–240.
- Grady JD, Burnett JW. Irukandji-like syndrome in South Florida divers. Ann Emerg Med. 2003; 42(6): 763–766.
- Huynh TT, Seymour J, Pereira P, et al. Severity of Irukandji syndrome and nematocyst identification from skin scrapings. Med J Aust. 2003; 178(1): 38–41.
- Burnett JW, Weinrich D, Williamson JA, et al. Autonomic neurotoxicity of jellyfish and marine animal venoms. Clin Auton Res. 1998; 8(2): 125–130.
- Cheng AC, Winkel KD, Hawdon GM, et al. Irukandji-like syndrome in Victoria. Aust N Z J Med. 1999; 29(6): 835.
- Pender AM, Winkel KD, Ligthelm RJ. A Probable Case of Irukandji Syndrome in Thailand. J Travel Med. 2006; 13(4): 240–243.
- Thaikruea L, Siriariyaporn P, Wutthanarungsanm R, et al. Toxic jellyfish situation in Thailand. Chiang Mai Med J. 2012; 51(4): 93–102.
- Cegolon L, Heymann WC, Lange JH, et al. Jellyfish stings and their management: a review. Mar Drugs. 2013; 11(2): 523–550.
- Thaikruea L, Siriariyaporn P. First aid and treatment. In: Injuries and Deaths Caused by Toxic Jellyfish: Surveillance, Prevention, and Treatment. Chiang Mai: Faculty of Medicine of Chiang Mai University. 2018: 115–156.
- Thaikruea L, Leelarasamee A. Which First Aid Treatment Is Appropriate for a Bizarre Skin Lesion and Cardiovascular Collapse after Swimming in the Sea? J Med Assoc Thai. 2018; 101(8): 1143–1144.
- Markenson D, Ferguson JD, Chameides L, et al. First Aid Chapter Collaborators. Part 13: First aid: 2010 American Heart Association and American Red Cross International Consensus on First Aid Science With Treatment Recommendations. Circulation. 2010; 122(16 Suppl 2): S582–S605.
- Fenner PJ, Hadok JC. Fatal envenomation by jellyfish causing Irukandji syndrome. Med J Aust. 2002; 177(7): 362–363.
- Thaikruea L, Siriariyaporn P. Diagnoses for injuries and deaths. In:, editor. Injuries and Deaths Caused by Toxic Jellyfish: Surveillance, Prevention, and Treatment. Chiang Mai: Faculty of Medicine of Chiang Mai University. 2018: 85–114.
- Desax-Willer D, Krebs T, Christen S. Delayed deep dermal necrosis after jellyfish sting in a 4-year-old female infant. Case Reports Plast Surg Hand Surg. 2018; 5(1): 75–79.
- Nickson CP, Waugh EB, Jacups SP, et al. Irukandji syndrome case series from Australia's Tropical Northern Territory. Ann Emerg Med. 2009; 54(3): 395–403.
